General Orthopedics and Osteopathic Principles
Core concepts
General orthopedics rewards a systematic approach to bone biology, fracture healing and the osteopathic framework. Know the phases of secondary fracture healing - hematoma and inflammation, soft callus, hard callus, remodeling - and the factors that delay it (smoking, NSAIDs, infection, instability, diabetes, steroids). Understand remodeling as coupled osteoclast–osteoblast activity; that coupling explains stress shielding, disuse osteopenia and periprosthetic loosening.
Osteopathic principles tested are few but easily confused. Somatic dysfunction is diagnosed by TART: tissue texture change, asymmetry, restriction of motion, tenderness. It is a functional diagnosis, not a fracture, infection or tumor. Fryette laws: Type I (neutral) mechanics produce group curves with sidebending and rotation to opposite sides; Type II (non-neutral) mechanics involve a single segment with sidebending and rotation to the same side.
Treatment modalities: muscle energy uses patient contraction against a counterforce with post-isometric relaxation; counterstrain places the segment in a position of ease over a tender point; HVLA is avoided with fracture, malignancy, instability or anticoagulation; myofascial release and lymphatic techniques address soft tissue and edema.
Trap: attributing a structural complaint to a visceral cause, or manipulating a patient with red flags - night pain, weight loss, fever, neurologic deficit - who needs imaging and workup first.
Worked example: in a single thoracic segment, sidebending and rotation to the same side is Type II non-neutral dysfunction; treat the segment, not the whole curve.
Rule of thumb: TART plus no red flags equals somatic dysfunction; anything else needs a diagnosis before treatment.